Testing Catalog

A COMPLETE GUIDE TO ZRT LABORATORY

www.zrtlab.com Table of Contents

About ZRT Laboratory...... 1

A Note from our Founder...... 2

The ZRT Difference ...... 3

Overview of Kits ...... 5

Multiple Testing Options – Your Choice...... 7

Our Comprehensive Range of Test Specialties ...... 11

Reproductive Hormone Testing...... 13

Hormone Metabolites ...... 18

Adrenal/Stress Testing ...... 19 The only way to know if hormones Thyroid Testing ...... 20 are in balance is to test them. Heavy Metals & Essential Elements Testing ...... 22 Neurotransmitter Testing ...... 24

Wellness Testing ...... 29

Methylation & Memory Testing ...... 30

Understanding ZRT’s Test Report ...... 31

Directory of Tests & CPT codes ...... 33

Billing Practices...... 35

Clinical Research & Study Testing...... 37

General Information ...... 40 A NOTE FROM OUR FOUNDER ABOUT ZRT LABORATORY A Note from our Founder

We are the science behind testing.

Hormones produced by endocrine glands (ovaries, testes, thyroid, pituitary, pancreas, etc.) are About ZRT Laboratory released into the bloodstream where they bind to carrier proteins and are slowly released into tissues throughout the body.

Various body fluids have been successfully used to monitor the levels of hormones which include blood from venipuncture (serum or plasma), capillary whole blood (blood spot), saliva, and urine. The only way to know if hormones Blood is traditionally collected by venipuncture and separated into serum or plasma. Capillary blood are in balance is to test them. can also be collected from the fingertip or heel (in infants) and drops deposited onto filter paper  Est. 1998 - Portland, OR and dried, which is referred to as dried blood spot (DBS). Blood provides a convenient means to Therefore, it’s vital to partner with a lab that understands ZRT Laboratory is a CLIA-certified measure levels of and peptide hormones; however, it measures total circulating hormone subtle differences between testing methods, and has both commercial and research laboratory including hormone bound to carrier proteins and requires a separate calculation to determine how the experience and technology to deliver the most accurate founded by breast cancer researcher much of the hormone is bioavailable to target cells. Also, diurnal patterns of hormone production results. David Zava, Ph.D. ZRT Laboratory has cannot be measured conveniently in blood. pioneered innovative testing methods With numerous peer-reviewed studies validating that hormone for hormones, neurotransmitters, Saliva is a convenient matrix for measuring levels because the sample collection test results support symptomatology, science now recognizes heavy metals and more, offering is simple and non-invasive (just spit into a tube) and the amount of steroid is representative of the that hormones are a fundamental part of treating the whole health care professionals convenient bioavailable fraction available to tissues – about 1-5% of the total circulating in blood. Because of body. Evidence shows that hormonal imbalances are the root testing options in different body the lower concentration it challenges methods of detection and requires 10- to 100-fold greater cause of many chronic health issues. fluids including saliva, dried blood sensitivity in detection methods. Saliva cannot be used to test peptide hormones. spot, dried urine, and serum. Since it With 20 years of experience and results from over 11 million began, ZRT has maintained a singular Urine is also a convenient method for measuring total hormone production; it contains a high tests, ZRT Laboratory is a recognized leader in innovative focus: providing comprehensive concentration of steroid metabolites and is simple to collect. Dried urine is even easier to collect at and meaningful hormone and wellness testing, being the first and meaningful test results that only 4 time points during the day and permits evaluation of diurnal patterns of hormone production. to commercialize many tests now considered mainstream. assist health care providers, and Disadvantages are that it only looks at metabolites scheduled for disposal by the body. It is not Health care providers in all 50 states and 96 countries, and their patients, in making informed possible to determine how much active hormone is present in circulation. Also, it must be processed research teams worldwide, use our tests, including the CDC, treatment decisions. by enzyme digestion and is time consuming. Topical hormones cannot be monitored in urine as the NIH and many renowned universities. they are mostly excreted in bile and very little is detected in urine.

ZRT has developed convenient, at-home collection methods for all these options – giving maximum DR. DAVID ZAVA flexibility and optimal results for health care providers. FOUNDER

Breast cancer researcher and biochemist David Zava, PhD founded ZRT in 1998. His desire to innovate the science of hormone testing provides the guiding force David Zava behind development of all ZRT’s technology.

1 2 THE ZRT DIFFERENCE THE ZRT DIFFERENCE

The ZRT Difference When choosing a laboratory, it’s crucial to partner with a group that has unmatched expertise and state-of-the-art technology to deliver the most accurate results and make it easy for you to get on board.

Advancing the Science of Testing Comprehensive Test Reports

✔ Ongoing clinical research, published in peer-reviewed journals ✔ Test results correlate hormone levels with reported symptoms and presented at scientific meetings, in collaboration with investigators and hormone supplementation. around the world including the CDC, NIH, the military and academic research centers. ✔ All reports are physician-reviewed with individualized comments, and include previous test results to compare current and past hormone levels to monitor patient progress. Accuracy ✔ Secure, online access to test reports. ✔ We ensure accurate test results for low-concentration hormones such as by using an extraction process for saliva testing. Provider Support & Education ✔ Precision and accuracy are maintained with rigorous proficiency testing both internally and externally. ✔ On-call clinical consultants available without appointment to consult with medical practitioners regarding hormone testing and bioidentical treatment approaches. Flexibility & Convenience ✔ Complimentary educational webinars for medical professionals presented by ✔ We offer all four test mediums (saliva, blood spot, dried urine, and serum) physician experts in the areas of physiology and endocrinology; complimentary and a varied menu of tests, allowing maximum flexibility and optimal patient education webinars. timing of sampling. ✔ Patient education brochures and point-of-sale displays. ✔ First-morning saliva sampling measures peak hormone levels and ensures correspondence with supplementation ranges that depend on time since ✔ Online access to resource materials, webinars, and reference documents. last hormone use. No need to collect four daily samples except when testing diurnal . ✔ Discounted yearly testing for provider employees.

✔ We determine reference ranges for individual patient ages, menstrual status, and hormone supplementation, so patients don’t need to stop taking hormones to use our testing.

✔ Turn-around time 3-5 business days.

3 4 OVERVIEW OF KITS | SPECIALTY KITS OVERVIEW OF KITS | STANDARD KITS Overview of Kits | Standard Kits Overview of Kits | Specialty Kits

SALIVA NEUROTRANSMITTERS HEAVY METALS &  Female / Male Saliva Profile I: E2, Pg, T, DS, C  Hormone Trio - Saliva: E2, Pg, T  NeuroAdvanced Profile: ESSENTIAL ELEMENTS  Female / Male Saliva Profile II: E2, Pg, T, DS, Cx2  Adrenal Stress: DS, Cx4 Dried Urine: GABA, Glu, Gly, DA,  Iodine Panel  Female / Male Saliva Profile III: E2, Pg, T, DS, Cx4  Diurnal Cortisol: Cx4 Epi, NE, HIST, 5-HT, PEA, DOPAC, I, Crtn HVA, 5-HIAA, NMN, VMA Trp, Kyn,  LCMS Saliva Steroid Profile:E2, E3, E1, EE, PregS, 3-OHkyn, Tau, Gln, His, N-MeHist,  Toxic & Essential Elements - Urine Pg, AlloP, 17OHPg, Adione, T, DHT, D, DS, 7keto, Tyra, KynAc, Xanth, Tyr & Crtn I, Br, Se, Li, As, Cd, Hg, Crtn 11DC, C, Cn, Ccn, Ald, Mel, ANZ, FIN, LTZ  Toxic & Essential Elements - Blood URINE METABOLITES Zn, Cu, Mg, Se, Cd, Pb, Hg  Adrenal Profile DRIED BLOOD SPOT  Comprehensive Toxic & Essential Elements  Essential Profile Blood Spot: Zn, Cu, Mg, Se, Cd, Pb, Hg  Female Blood Profile I:  : 25-OH D2, 25-OH D3, total  Estrogen Elite Profile Urine: I, Br, Se, Li, As, Cd, Hg, Crtn E2, Pg, T, SHBG, DS, C  CardioMetabolic Profile:  Basic Metabolites Profile  Elite Thyroid Profile In, hsCRP, HbA1c, TG, CH, HDL, LDL, VLDL  Female Blood Profile II:  Advanced Metabolites Profile T4, Tgbn, TSH, fT3, fT4, TP0ab E2, Pg, T, SHBG, DS, C, TSH, fT3, fT4, TPOab  Toxic & Essential Elements - Blood: Zn, Cu, Mg, Se, Cd, Pb, Hg  Male Blood Profile I: SLEEP BALANCE  Essential Thyroid Profile: E2, T, PSA, SHBG, DS, C  Dried Urine: Melatonin WEIGHT MANAGEMENT TSH, fT3, fT4, TPOab (MT6s) x4,Free Cortisol x4,  Male Blood Profile II:  Saliva: E2, Pg, T, DS, Cx4  Elite Thyroid Profile: E2, T, PSA, SHBG, DS, C, TSH, fT3, fT4, TPOab Free x4, Crtn Blood Spot: TSH, 25-OH D2, 25-OH D3, T4, Tgbn, TSH, fT3, fT4, TP0ab  Hormone Trio - Blood: E2, Pg, T HbA1c, In

ADRENAL STRESS SALIVA + BLOOD  Saliva: DS, Cx4  Comprehensive Female Profile I:  Comprehensive Male Profile I: The Wellness Suite Saliva: E2, Pg, T, DS, Cx4 Saliva: E2, T, DS, Cx4 Blood Spot: TSH, fT3, fT4, TPOab Blood Spot: PSA, TSH, fT3, fT4, TPOab  Comprehensive Female Profile II:  Comprehensive Male Profile II: Saliva: Cx4 Saliva: Cx4 CORTISOL AWAKENING WELLNESS METRICS Blood Spot: E2, Pg, T, SHBG, DS, Blood Spot: E2, T, SHBG, PSA, DS, TSH, RESPONSE  Saliva: E2, Pg, T, DS, Cx4 TSH, fT3, fT4, TPOab fT3, fT4, TPOab  Saliva: DS, Cx6 Blood Spot: TSH, D2/D3, In, HbA1c

BLOOD + URINE  Comprehensive Thyroid Profile:  Comprehensive Toxic & Essential Elements Dried Urine: I, Se, Br, Li, As, Cd, Hg, Crtn Blood Spot: Zn, Cu, Mg, Se, Cd, Pb, Hg MENSTRUAL CYCLE FITNESS METRICS Blood Spot: T4, Tgbn, TSH, fT3, fT4, TPOab Urine: I, Br, Se, Li, As, Cd, Hg, Crtn MAPPING  Blood Spot: E2, Pg, T, DS, C, SHBG,  Dried Urine: E1G, PDG, LH, TSH, D2/D3, TG, CH, HDL, LDL, VLDL Crtn

BLOOD DRAW  Female Serum Hormones Basic Profile:  Methylation Profile: FERTILITY ELITE ATHLETE METRICS E2, Pg, T, SHBG, DS, C, TSH FER, FOL, HCY, B12  Saliva: Cx4  Saliva: E2, Pg, T, DS, Cx4  Female Serum Hormones Advanced Profile:  Methylation & Memory Basic Profile: Blood Spot: E2, Pg, T, SHBG, Blood Spot: TSH, fT3, fT4, TPOab, D2/D3 E2, Pg, T, SHBG, DS, C, TSH, fT3, fT4, E2, Pg, T, TSH, FOL, HCY, B12, BDNF DS, TSH, fT3, fT4, TPOab, TPOab, FSH, LH, FER  Methylation & Memory Advanced Profile: FSH, LH  Male Serum Hormones Basic Profile: E2, Pg, T, SHBG, DS, C, TSH, fT3, fT4, E2, T, PSA, SHBG, DS, C, TSH TPOab, FER, FOL, B12, HCY, BDNF  Male Serum Hormones Advanced Profile: About ZRT Laboratory Test Kits E2, T, PSA, SHBG, DS, C, TSH, fT3, fT4, TPOab, LH, PRL, FER Our all-inclusive test kits are simple and convenient for both patients and providers. All kits (except serum) are designed for private sample collection at home, at the optimal time. 5 6 TESTING OPTIONS 8

Endogenous levels are identical in serum and blood spot. Endogenous sex hormone levels are therapy is used, blood spot has But when topical or vaginal hormone an advantage in that it reflects tissue uptake of the administered hormone. Saliva testing can be used to monitor all types of hormone supplementation the except troche/sublingual hormones because of direct contamination of sample with the administered hormone. Dried urine is generally not suitable for monitoring sex hormone replacement to because it does not reflect tissue uptake of topical , is subject contamination with vaginally delivered hormones, and hormone metabolites interfere with testing levels of oral and pellet dosage forms. Measuring steroid hormone metabolites, e.g., for breast cancer risk Measuring steroid hormone metabolites, and iodine/selenium sufficiency Determining toxic element exposure for thyroid health at 4 time points for stress assessment Determining diurnal cortisol production production Assessing nocturnal and diurnal melatonin replacement therapy Monitoring topical or intravaginal hormone • • • DRIED URINE TESTING DRIED URINE Suitable for: • assessment • • • Not suitable for: • Media Following Sex Steroid Hormones in Different Test Testing Different Routes of Hormone Administration Testing for Steroid Hormone Levels Testing patients cope with hormone health care practitioners face the challenge of helping Today’s is optimal. imbalance. Accurate testing is the best way to make sure hormone dosing learn more, visit www.zrtlab.com/sample-types/hormone-testing-for-different-supplementation-types/ To

best

Toxic and nutritional elements requiring a whole blood sample Toxic of sample at home at a time convenient to the patient Self-collection and avoiding a trip to the phlebotomist Patients with dry mouth and/or children who may have difficulty collecting with dry mouth and/or children who may Patients Monitoring hormone replacement therapy (oral, sublingual, pellet) Assessing thyroid health, fertility parameters, and cardiometabolic risk Assessing interstitial tissue/capillary hormone levels reflecting topical or vaginal hormone supplementation Monitoring sublingual/troche hormone replacement Monitoring sublingual/troche hormone dry mouth, e.g., due to Sjogren’s Syndrome with Patients Assessing total circulating hormone levels (free plus protein-bound) Assessing “free” (unbound to carrier proteins) hormone levels Assessing “free” (unbound to carrier vaginally topically, orally, Monitoring hormone replacement given or via pellets e.g., determining diurnal a day, Collecting multiple samples during cortisol levels for adrenal stress assessment • • • saliva • • factors Dried Blood Spot better for: • • • TESTING BLOOD SPOT OR SERUM DRIED BLOOD Suitable for: • SALIVA TESTING SALIVA TESTING Suitable for: • • • Not suitable for: for your and your patient’s needs. Here is a guide to the merits patient’s needs. Here is for your and your option of each test medium. Multiple Testing Options Options Testing Multiple Choice – Your can choose the 4 different test media so you offers testing in ZRT

TESTING OPTIONS 7 TEST SPECIALTIES TEST SPECIALTIES Our Comprehensive Heavy Metals & Essential Elements Testing ������������������������������ Pages 22-24 Range of Test Specialties Exposure to dangerous heavy metals or insufficiency of nutritional elements affects health profoundly. Testing elements in the most appropriate sample type is important for proper assessment.

 Iodine Panel in Dried Urine Reproductive Hormone Testing ���������������������������������������������� Pages 11-18  Toxic & Essential Elements – Urine  Toxic & Essential Elements – Blood Keeping hormones in balance means testing to ensure levels are within physiological, age-  Comprehensive Toxic & Essential Elements Profile appropriate ranges. Our range of testing options covers your assessment needs for menopause, andropause, menstrual health, fertility, and breast cancer risk.

 Female/Male Saliva Profiles I, II & III Neurotransmitter Testing ����������������������������������������������������� Pages 25-27  Female Blood Profiles I & II Testing neurotransmitters can help pinpoint imbalances leading to many mood disorders.  Male Blood Profiles I & II Choose our NeuroAdvanced profile alone or add on any of the available options – sex  Hormone Trio – Saliva hormones, diurnal cortisol, elements, or melatonin – to get a more complete picture, giving  Hormone Trio – Blood Spot practitioners a diagnostic edge to help identify treatment options.  Comprehensive Female Profiles I & II  Comprehensive Male Profiles I & II  NeuroAdvanced Profile  Female Serum Hormones – Basic & Advanced Profiles  Male Serum Hormones – Basic & Advanced Profiles  Fertility Profile Wellness Testing ��������������������������������������������������������������� Pages 28-29  Menstrual Cycle Mapping Optimal wellness means getting to grips with modifiable lifestyle factors that can have a big  LCMS Saliva Steroid Profile impact on health. Whether assessing vitamin D deficiency, risk factors for cardiovascular  Urine Metabolites disease and diabetes, barriers to healthy sleep, or hormone imbalances hindering your path to fitness, our profiles offer multiple testing options.

Adrenal/Stress Testing �������������������������������������������������������� Page 19  Weight Management Profile  Sleep Balance Profile Assessment of diurnal cortisol levels is key to detecting adrenal dysfunction that leads to many  CardioMetabolic Profile stress-related health problems.  Wellness Metrics Profile  Diurnal Cortisol Profile  Fitness Metrics Profile  Adrenal Stress Profile  Elite Athlete Metrics Profile  Cortisol Awakening Response Profile

Methylation & Memory Testing ���������������������������������������������� Pages 30-31 Thyroid Testing ����������������������������������������������������������������� Page 20-21 Nutritional factors involved in methylation pathways are vital to the health of the Proper thyroid function is essential to maintaining the body’s metabolic activity and regulating cardiovascular and nervous systems and to safe steroid hormone metabolism. Our profiles energy. Our profiles identify overt and subclinical thyroid disease and monitor thyroid replacement. assess these factors as well as multiple hormones and BDNF. If these are not at optimal Get a more complete picture with profiles that combine thyroid tests with our other hormone testing levels, risks for cardiovascular disease and dementia can increase. or with heavy metals and essential elements tests that affect thyroid health.  Methylation Profile  Essential & Elite Thyroid Profiles  Methylation & Memory – Basic & Advanced Profiles  Comprehensive Thyroid Profile  Comprehensive Female Profiles I & II  Comprehensive Male Profiles I & II 9 10 TEST SPECIALTIES | SEX HORMONE PROFILES TEST SPECIALTIES | SEX HORMONE PROFILES Hormone Trio - Saliva Consider for Women: Female / Male Saliva Profiles I, II & III Consider for Women: Baseline levels before hormone replacement Baseline levels before hormone replacement Combines three of our most popular saliva hormone therapy, amenorrhea, PMS, DUB (dysfunctional Three convenient saliva profiles are offered to assesssex therapy, amenorrhea, PMS, dysfunctional uterine tests at a lower price than individual tests. uterine bleeding), estrogen dominance symptoms, and adrenal hormone levels. These profiles test waking bleeding (DUB), estrogen dominance symptoms, hypogonadism, sexual dysfunction, osteoporosis, levels of estradiol, , , DHEA-S, hypogonadism, sexual dysfunction, osteoporosis, ✔ Hormone Trio includes: E2, Pg, T fibrocystic breast disease, PCOS screening, and cortisol, while Profile II includes a bed-time cortisol fibrocystic breast disease, infertility screening, anovulation, menopausal symptoms. Ideal for test and Profile III a full diurnal cortisol profile at four time polycystic ovarian syndrome (PCOS) screening, monitoring HRT dosing. points during the day (morning, noon, evening, night). anovulation, menopausal symptoms, screening for adrenal fatigue. Ideal for monitoring HRT dosing. Consider for Men: ✔ Saliva Profile I includes: E2, Pg, T, DS, C Monitor for estrogen dominance, hypogonadism, ✔ Saliva Profile II includes: E2, Pg, T, DS, Cx2 Consider for Men: andropause, fatigue, low libido, erectile dysfunction, ✔ Saliva Profile III includes: E2, Pg, T, DS, Cx4 Monitor for estrogen dominance, hypogonadism, osteoporosis screening. andropause, fatigue, low libido, erectile dysfunction, infertility, osteoporosis screening, and adrenal dysfunction.

Hormone Trio - Blood Spot Consider for Women: Baseline levels before hormone replacement Female Blood Profile I tests the primary female sex Female Blood Profiles I & II Combines three of our most popular hormone tests therapy, amenorrhea, PMS, DUB (dysfunctional hormones and their major binding globulin, and at a lower price than individual tests. uterine bleeding), estrogen dominance symptoms, Two dried blood spot profiles are offered for women: screens for adrenal health through morning cortisol. Profile I tests sex and adrenal hormone levels in blood, hypogonadism, sexual dysfunction, osteoporosis, ✔ Hormone Trio includes: E2, Pg, T as an alternative to Saliva Profile I for those women who Consider for assessment of total baseline levels fibrocystic breast disease, PCOS screening, have difficulty producing enough saliva for testing, or who before hormone replacement therapy, adrenal anovulation, menopausal symptoms. Ideal for are using sublingual hormones that might interfere with fatigue, amenorrhea, anovulation, DUB (dysfunctional monitoring HRT dosing. uterine bleeding), estrogen dominance symptoms, the saliva test. SHBG is included in the profile so that free Consider for Men: fibrocystic breast disease, hypogonadism, infertility (unbound) testosterone can be calculated, since most Monitor for estrogen dominance, hypogonadism, screening, menopausal symptoms, osteoporosis, of the testosterone circulating in the blood is bound to andropause, fatigue, low libido, erectile PCOS screening, PMS, sexual dysfunction. SHBG. Profile II includes the same tests as Profile I with dysfunction (ED), osteoporosis screening. the addition of the Essential Thyroid Profile tests. Female Blood Profile II is a more comprehensive ✔ Female Blood Spot Profile I includes: assessment of hormonal and thyroid imbalances. E2, total; Pg, total; T, total; SHBG; DS; C The Female Serum Profile includes the same tests. ✔ Female Blood Spot Profile II adds: Comprehensive Female Profile I combines ZRT’s TSH, fT3, fT4, TPOab Comprehensive Female Profiles popular Salivary Hormone Profile III with our ✔ Female Serum Profile includes: These profiles include both saliva and dried blood spot Essential Thyroid Profile tests in dried blood spot. E2, Pg, T, SHBG, DS, C,TSH, fT3, fT4, TPOab tests, and provide a broad assessment of possible hormonal imbalances because they assess sex, Comprehensive Female Profile II tests only the adrenal, and thyroid hormone levels. These three diurnal cortisol in saliva, while the sex and thyroid hormone systems work in harmony, and an imbalance hormones are all tested in dried blood spot. in one system affects the balance of the others as well. Allows physicians to assess baseline levels before Male Blood Profile I tests the primary male sex Male Blood Profiles I & II Comprehensive testing allows the health care provider hormone replacement therapy; ideal for monitoring hormones and their major binding globulin, and to determine appropriate treatment to restore balance HRT dosing. Full assessment of thyroid health, Two dried blood spot profiles are offered for men: screens for adrenal health through morning cortisol. and achieve overall wellness. including screening for hypo or hyperthyroidism, Profile I tests sex and adrenal hormone levels in blood, Consider for monitoring for estrogen dominance, determining Free T4 levels as well as Free T3 and includes a PSA test to help assess prostate health. hypogonadism, andropause, fatigue, low ✔ Comprehensive Female Profile I includes: levels, testing for autoimmune thyroid disease, and Profile II includes the same tests as Profile I with the libido, erectile dysfunction (ED), infertility, Saliva: E2, Pg, T, DS, Cx4 monitoring thyroid replacement dosage. addition of the Essential Thyroid Profile tests. osteoporosis screening, adrenal dysfunction. Blood Spot: TSH, fT3, fT4, TPOab Consider for: ✔ Comprehensive Female Profile II includes: ✔ Male Blood Spot Profile I includes: Amenorrhea, PMS, DUB (dysfunctional uterine Male Blood Profile II is a more comprehensive Saliva: Cx4 E2, total; T, total; PSA; SHBG; DS; C bleeding), estrogen dominance symptoms, assessment of hormonal and thyroid imbalances. Blood Spot: E2, total; Pg; T, total; SHBG; hypogonadism, sexual dysfunction, osteoporosis, ✔ Male Blood Spot Profile II adds: The Male Serum Profile includes the same tests. DS; TSH; fT3; fT4; TPOab fibrocystic breast disease, infertility screening, TSH, fT3, fT4, TPOab  Don’t need PSA? Select one of the female PCOS screening, anovulation, menopausal ✔ Male Serum Profile includes: profiles instead. symptoms, screening for adrenal dysfunction, E2, T, PSA, SHBG, DS, C, TSH, fT3, fT4, TPOab and thyroid dysfunction. 11 12 TEST SPECIALTIES | SEX HORMONE PROFILES TEST SPECIALTIES | SEX HORMONE PROFILES Comprehensive Male Profiles Comprehensive Male Profile I combines a male version Male Serum Hormones Consider for: of ZRT’s popular Salivary Hormone Profile III with our Fatigue, sleep disturbance, These profiles include both saliva and dried blood spot Essential Thyroid Profile in dried blood spot. For men, – Basic & Advanced Profiles decreased cognition, depression, low tests, and provide a broad assessment of possible PSA is included instead of the less relevant (for men) libido, erectile dysfunction, infertility, hormonal imbalances because they assess sex, adrenal, salivary progesterone. Serum testing of sex hormones can be used to determine loss of bone & muscle mass, weight and thyroid hormone levels. These three hormone systems circulating endogenous hormone levels in men who are gain, adrenal and thyroid dysfunction. work in harmony, and an imbalance in one system affects Comprehensive Male Profile II tests only the diurnal not using topical hormone supplementation (see our dried the balance of the others as well. Comprehensive testing cortisol in saliva, while the sex and thyroid hormones blood spot or saliva testing options for men using hormone allows the health care provider to determine appropriate are all tested in dried blood spot. Allows physicians therapy). Basic profiles are a good start for testing proper treatment to restore balance and achieve overall wellness. to monitor for estrogen dominance, hypogonadism, balance of sex hormones, adrenal hormones, and TSH. andropause; full assessment of thyroid health, including The advanced profile provides a broader overview of the ✔ Comprehensive Male Profile I includes: screening for hypo or hyperthyroidism, determining health and balance of sex and thyroid hormones, and Saliva: E2, T, DS, Cx4 Free T4 levels as well as Free T3 levels, testing for include LH which, if low, can indicate excessive testosterone Blood Spot: PSA, TSH, fT3, fT4, TPOab autoimmune thyroid disease, and monitoring thyroid supplementation. Iron status, important for thyroid health, is replacement dosages. assessed with ferritin measurement. PSA and prolactin are ✔ Comprehensive Male Profile II includes: included as a prescreen for testosterone therapy to exclude Saliva: Cx4 Consider for: prostate issues and pituitary prolactinoma. Blood Spot: E2, total; T, total; SHBG; DS; PSA; TSH; fT3; fT4; Fatigue, sleep disturbance, decreased cognition, TPOab depression, low libido, erectile dysfunction (ED), ✔ Male Serum Hormones Basic Profile includes: infertility, loss of bone and muscle mass, weight E2, T, PSA, SHBG, DS, C, TSH gain, adrenal and thyroid dysfunction. ✔ Male Serum Hormones Advanced Profile includes: E2, T, PSA, SHBG, DS, C, TSH, fT3, fT4, TPOab, LH, PRL, FER  Don’t need PSA? Select one of the female profiles instead.

Fertility Profile Fertility Profile meets the requirement for initial screening for fertility assessment The profile provides a thorough evaluation that can by reproductive endocrinologists. identify many problems related to hormone imbalances Assessment of ovarian reserve as well as Female Serum Hormones Consider for: that are associated with infertility. Dried blood spot screening for multiple common reasons samples are collected on days 3 and 21 of the menstrual – Basic & Advanced Profiles Amenorrhea, PMS, dysfunctional uterine bleeding, for infertility including: anovulation, PCOS, estrogen dominance symptoms, hypogonadism, cycle, and saliva samples are collected only on day hypothyroidism, premature ovarian failure 21. LH and FSH are tested on day 3, while on day 21 Serum testing of sex hormones can be used to determine sexual dysfunction, osteoporosis, fibrocystic or ovarian insufficiency. estradiol, progesterone, testosterone, DHEA-S, SHBG, circulating endogenous hormone levels in women who breast disease, infertility screening, PCOS and the thyroid hormones are tested in dried blood spot are not using topical or vaginal hormone supplementation screening, anovulation, menopausal symptoms, Consider for: adrenal and thyroid dysfunction. and diurnal cortisol is tested in saliva. (see our dried blood spot or saliva testing options for Women who have been trying to get women using hormone therapy). Basic profiles are a ✔ Fertility Profile includes: pregnant without success, or who would good start for testing proper balance of sex hormones, Saliva: Cx4 like to be proactive in their preconception adrenal hormones, and TSH. Advanced profiles provide Blood Spot: E2, total; Pg; T, total; SHBG; DS; TSH; fT3; fT4; planning by getting a baseline screening. a broader overview of the health and balance of sex and TPOab; FSH; LH thyroid hormones, and they include pituitary hormones that control ovarian production of the sex hormones and help define menopausal status. Iron status, important for thyroid health, is assessed with ferritin measurement. Consider for: ✔ Female Serum Hormones Basic Profile includes: Menstrual Cycle Mapping Consider for women with irregular cycles, E2, Pg, T, SHBG, DS, C, TSH This profile offers an assessment of sex hormone cyclic hormone-related symptoms such and LH patterns throughout a menstrual cycle to help ✔ Female Serum Hormones Advanced Profile includes: as pre-menstrual syndrome (PMS) or health care practitioners get to the root of hormone- headaches, infertility, or luteal phase defects E2, Pg, T, SHBG, DS, C, TSH, fT3, fT4, TPOab, FSH, LH, FER related menstrual symptoms, irregular cycles, to determine the source of their problems. amenorrhea, or infertility. Dried urine testing provides a simple and convenient way to assess fluctuations in daily hormone levels over an entire month, known as menstrual cycle mapping.

✔ Menstrual Cycle Mapping includes: Dried Urine: E1G, PDG, LH 13 14 TEST SPECIALTIES | HORMONE METABOLITES TEST SPECIALTIES | SEX HORMONE PROFILES LCMS Saliva Steroid Profile Consider for Women: Urine Hormone Metabolites Profiles Hair loss, acne, PCOS, topical DHEA or 7-keto The profile includes 23 tests all reported together DHEA supplementation, hormonal birth control from one convenient morning saliva collection. Tests users, adrenal dysfunction, or those treated with Five profiles give a broad range of choices for an assessment of how patients are metabolizing a variety include a broad range of bioavailable , hormone blockers for breast cancer. of hormones. , and and ourtesy of They include: their metabolites; plus melatonin, ethinyl estradiol and Consider for Men: theSaliva hormone Steroid blockers anastrozole, Cascade finasteride and Hypogonadism, andropause, BPH,  A wide array of estrogen, progesterone, and metabolites useful for assessment of breast cancer risk letrozole. This provides a comprehensive picture of adrenal dysfunction, monitoring hormone  metabolites, diurnal free cortisol, and diurnal free cortisone for adrenal assessment hormonal status and how hormonal birth control and supplementation.  Diurnal 6-sulfatoxymelatonin (MT6s) to assess sleep / wake cycle dysfunction hormone blockers are affecting endogenous hormone availability. regnenolone ulfate A- -eto A  The xenoestrogen Bisphenol A (BPA)

Sex steroid hormone metabolites results are useful for monitoring hormone therapy patients using patches, pellets ✔ LCMS Saliva Steroid Profile Includes:U U β or injectables. E2, E3, E1, EE, PregS, Pg, AlloP, 17OHPg, Adione, T, DHT, yase D, olesterolDS, 7keto, 11DC, C, Cn,renenolone Ccn, Ald, Mel, ANZ, FIN, LTZ renenolone A Anrosteneiol

β

α α α- yase rogesterone -O rogesterone estosterone ourtesy of Adrenal Profile SalivaSaliva Steroid Steroid Cascade Cascade A A α ✔ A picture of adrenal hormone metabolism. A,

Consider for patients with adrenal dysfunction or stress. Useful as a second step of testing for those with eoycorticosterone -eoxcortisol strone stradiol adrenal fatigue symptoms, but whose saliva cortisol levels are normal (i.e., may indicate hyperexcretion of cortisol / excessive conversion to cortisone). Useful as a screening test for Addison’s or Cushing’s disease. β A regnenolone ulfate A- β-eto A

U U ββ orticosterone ortisol striol Estrogen Essential Profile yase olesterol renenoloneA β renenoloneβ A Anrosteneiol ✔ A baseline view of how a patient is metabolizing estrogens.

β Consider for anyone with a personal or family history of estrogen-dependent cancer (e.g., breast cancer).

α ortisone α α- yase Allopregnanolone rogesterone -O rogesterone Androstenedione estosterone Estrogen Elite Profile A A α A, ✔ Estrogen, progesterone, and select androgen metabolites with BPA. Consider for anyone with a personal or family history of estrogen-dependent cancer (e.g., breast cancer), eoycorticosterone -eoxcortisol strone stradiol patients with symptoms of estrogen/progesterone imbalance, men with prostate cancer risk, or patients who want to assess their exposure to BPA. β A β

β orticosterone ortisol striol Basic Profile

A β β ✔ A baseline view of sex steroid hormone metabolite levels plus total cortisol. Consider as a baseline assessment for hormone replacement therapy.

Aldosterone ortisone

Abbreviation ey Also este y Advanced Profile ✔ Our broadest view of sex steroid hormone metabolite levels and cortisol metabolism, with full diurnal melatonin and BPA. A Aromatase teroid nthesis nhibitors tinyl straiol Consider as a comprehensive assessment for patients at risk of breast cancer, patients with symptoms of A Alosterone yntase A Anastrozole Melatonin ulfotransferase inasterie estrogen / progesterone imbalance, men with prostate problems, and patients who want to assess exposure U ulfatase etrozole to BPA. Also beneficial for patients struggling with weight or insulin resistance, who have signs of adrenal dysfunction, or who have sleep problems affecting health.

Analtes in bold are reported b 15 16

Abbreviation ey Also este y

A Aromatase teroid nthesis nhibitors tinyl straiol A Alosterone yntase A Anastrozole Melatonin ulfotransferase inasterie U ulfatase etrozole

Analtes in bold are reported b TEST SPECIALTIES | STEROID HORMONE CASCADE TEST SPECIALTIES | HORMONE METABOLITES Urine Hormone Metabolites Profiles

Urine Metabolites Profile Options Adrenal Estrogen Essential Estrogen Elite Basic Advanced Steroid Hormone Cascade ESTROGENS Courtesy of Estradiol (E2)     The Steroid Hormone Cascade (E1)     Boxed metabolites are reported by ZRT. (E3)     2-Hydroxy Estradiol (2-OH E2)    CYPscc 2-Hydroxy Estrone (2-OH E1)    3β-HSD 17α-OH 17-OH Pregnenolone 4-Hydroxy Estradiol (4-OH E2)    3β-HSD 17, 20-Lyase 4-Hydroxy Estrone (4-OH E1)    16 -Hydroxy Estrone (16 -OH E1)    α α 17α-OH 17β-HSD Progesterone 17-OH Progesterone DHEA 2-Methoxy Estradiol (2-MeO E2)    3β-HSD 5β-R, 3α-HSD, 20α-HSD 5β-R, 3α-HSD, 20α-HSD 2-Methoxy Estrone (2-MeO E1)    3β-HSD 5β-R, 3α-HSD Pregnanetriol 4-Methoxy Estradiol (4-MeO E2)    17, 20-Lyase 5α-R, 3α-HSD Androstenedione 4-Methoxy Estrone (4-MeO E1)    Allo- 17α-HSD 17β-HSD Bisphenol A (BPA)   20α-HSD 5α-R, 3α-HSD PROGESTOGENS Allo-Pregnanediol 5α-R Epi-Testosterone Testosterone 5α-DHT

Pregnanediol (Pgdiol)    3α-HSD 3α-HSD Allopregnanolone (AlloP)    3α- 5α, 3α-Androstanediol 20α-HSD (AlloPd)  21-OH 20α-Dihydroprogesterone AR AR  3α-Dihydroprogesterone (3αHP) β 11-Deoxycortisol 17β-HSD 20α-Dihydroprogesterone (20αHP)  Estrone (E1) 17β-Estradiol (E2) CYP1A1 CYP1B1 Deoxycorticosterone (DOC)  11β-OH (Ccn)  11β-HSD Cortisone Cortisol 2OH-E2 2OH-E1 4OH-E2 4OH-E1 ANDROGENS 5β-R 5β-R 3α-HSD 3α-HSD COMT COMT COMT COMT DHEA (D)     2MeO-E2 2MeO-E1 4MeO-E2 4MeO-E1 Androstenedione (Adione)    Androsterone (Andro)  CYP3A4 21-OH Etiocholanolone (Etio)  Deoxycorticosterone 16α-OH E1

Testosterone (T)    11β-OH 17β-HSD

Epi-Testosterone (Epi-T)    Corticosterone Estriol (E3) 5 - (5 -DHT)    α α AS  5α,3α-Androstanediol (5α3α) Aldosterone Total Cortisol (TC)    Enzyme Abbreviations Free Cortisol x4 (FC x4)   Androgens (5α-R) 5α-Reductase (11β-HSD) 11β- dehydrogenase Total Cortisone (TCn)   (5β-R) 5β-Reductase (17α-HSD) 17α-Hydroxysteroid dehydrogenase Estrogens (11β-OH) 11β-Hydroxylase (17β-HSD) 17β-Hydroxysteroid dehydrogenase Free Cortisone x4 (FCn x4)   Glucocorticoids (17α-OH) 17α-Hydroxylase (20α-HSD) 20α-Hydroxysteroid dehydrogenase 17,20-Lyase (same enzyme as 17α-OH) (AR) Aromatase Tetrahydrocortisol (ThC)   (21-OH) 21-Hydroxylase (AS) Aldosterone Synthase (3α-HSD) 3α-Hydroxysteroid dehydrogenase (CYP) Cytochrome p450 (scc, 1A1, 1B1 & 3A4)   Tetrahydrocortisone (ThCn) Progestogens (3β-HSD) 3β-Hydroxysteroid dehydrogenase (COMT) Catechol-O-Methyl-Transferase Melatonin x4 (MT6s x4) 

 Abbreviations in parentheses as they appear on test requisitions and test reports 17 18 TEST SPECIALTIES | THYROID PROFILES TEST SPECIALTIES | ADRENAL PROFILES

Diurnal Cortisol Profile Consider for: Essential & Elite Thyroid Profiles Essential Thyroid Profile provides assessment Stress, immune dysfunction, chronic fatigue, of thyroid health, including screening for hypo- The full diurnal cortisol profile at four time points and / or multiple symptoms of adrenal imbalance. Thyroid dysfunction can explain a wide variety of or hyperthyroidism, determining Free T4 and Free during the day. symptoms because of the central role of thyroid T3 levels, testing for autoimmune thyroid disease, hormones in directing the metabolic activity of cells. and monitoring thyroid replacement dosages. ✔ Diurnal Cortisol Profile includes: Cx4 A properly regulated thyroid is essential to a wide array of biochemical processes in the body. These profiles can Elite Thyroid Profile adds an indicator help detect both overt and subclinical thyroid disease, as of low iodine status and total T4 production by well as monitor thyroid replacement therapy. the thyroid gland. Consider for: Adrenal Stress Profile ✔ Available in Dried Blood Spot Consider for: Individuals under stress with multiple symptoms of Alopecia, anxiety, arthralgias, constipation, The profile tests the adrenal hormones DHEA-Sand ✔ Essential Thyroid Profile includes:TSH, fT3, fT4, TPOab adrenal imbalance, including immune dysfunction, depression, fatigue, Hashimotos, hyperlipidemia, diurnal cortisol. When individuals experience continuous fatigue, allergies, and sleep disturbances. ✔ Elite Thyroid Profile includes: T4, Tgbn, TSH, fT3, fT4, TP0ab hypertension, infertility, menstrual disorders stress, not only from emotional stressors (e.g., marital, (DUB, amenorrhea), mood disorders, obesity, financial, and occupational) but also from physical sleep disorders, and weight issues. stressors (e.g., sleep deprivation, caffeine consumption, pain, extreme exercise), it can lead to changes in adrenal hormone levels, related to disorders ranging from anxiety to infertility.

✔ Adrenal Stress Profile includes: Comprehensive Thyroid Profileallows doctors Saliva: DS, Cx4 Comprehensive Thyroid Profile to see if an individual has too little, or too much, This profile combines ZRT’s innovative Toxic & iodine and selenium, and / or exposure to the Essential Elements - Urine Profile with thyroid testing iodine / selenium antagonists bromine, arsenic, in dried blood spot for a more comprehensive thyroid and mercury; full assessment of thyroid health, Consider for: Cortisol Awakening Response assessment. including screening for hypo or hyperthyroidism, PTSD, major depression, chronic fatigue syndrome determines Free T4 and Free T3 levels, testing The Cortisol Awakening Response – also called CAR and other severe stress conditions. ✔ Comprehensive Thyroid Profile includes: for autoimmune thyroid disease, and monitoring – reveals more detailed clues that help in assessing Dried Urine: Iodine, Selenium, Bromine, Lithium, Arsenic, thyroid replacement dosages. adrenal hormone/HPA Axis dysfunction. Six cortisol Cadmium, Mercury collections in 24 hours is the most common method Blood Spot: T4, Tgbn, TSH, fT3, fT4, TPOab Consider for: for assessing CAR. Start saliva collection within five minutes of waking for the day, followed by a second Patients with thyroid dysfunction coupled with sample at 30 minutes, and a third sample at 60 minutes. concerns about toxic element exposure and The rest of the diurnal rhythm can be assessed at the iodine/selenium deficiency’s impact on T4 to T3 normal time intervals – noon, evening and night. conversion.

✔ Cortisol Awakening Response Profile includes: Saliva: DS, Cx6 19 20 TEST SPECIALTIES | HEAVY METALS ELEMENTS & ESSENTIAL TEST SPECIALTIES | THYROID PROFILES

Comprehensive Female Profiles Comprehensive Female Profile I combines ZRT’s Iodine Panel in Dried Urine Iodine Panel Allows physicians to see if an popular Salivary Hormone Profile III with our individual has too little, or too much, of the These profiles include both saliva and dried blood spot Essential Thyroid Profile tests in dried blood spot. Iodine deficiency can reduce thyroid hormone essential nutrient iodine. tests, and provide a broad assessment of possible synthesis leading to hypothyroidism. Conversely, too hormonal imbalances because they assess sex, Comprehensive Female Profile II tests only much iodine consumption can also cause thyroid Consider for: adrenal, and thyroid hormone levels. These three the diurnal cortisol in saliva, while the sex and problems. Iodine testing allows for determination of Patients with thyroid issues. hormone systems work in harmony, and an imbalance thyroid hormones are all tested in dried blood iodine status based on CDC and WHO guidelines  in one system affects the balance of the others as well. spot. Allows physicians to assess baseline levels for thyroid as well as extra-thyroidal sufficiency. Creatinine is measured in all samples to Comprehensive testing allows the health care provider before hormone replacement therapy; ideal correct results for urine dilution. to determine appropriate treatment to restore balance for monitoring HRT dosing. Full assessment of ✔ Iodine Panel includes: and achieve overall wellness. thyroid health, including screening for hypo or Dried Urine: Iodine hyperthyroidism, determining Free T4 levels as ✔ Comprehensive Female Profile I includes: well as Free T3 levels, testing for autoimmune Saliva: E2, Pg, T, DS, Cx4 thyroid disease, and monitoring thyroid Blood Spot: TSH, fT3, fT4, TPOab replacement dosage.

✔ Comprehensive Female Profile II includes: Consider for: Toxic & Essential Elements - Urine Allows Saliva: Cx4 Toxic & Essential Elements - Urine Amenorrhea, PMS, DUB (dysfunctional uterine physicians to see if an individual has too little, Blood Spot: E2, total; Pg; T, total; SHBG; bleeding), estrogen dominance symptoms, or too much, of the essential nutrients iodine DS; TSH; fT3; fT4; TPOab Iodine is an essential component of T3 and T4, so its hypogonadism, sexual dysfunction, osteoporosis, and selenium or the trace elements bromine deficiency has a serious impact on thyroid hormone fibrocystic breast disease, infertility screening, synthesis, while selenium is a component of the and lithium, or if they have been exposed to too PCOS screening, anovulation, menopausal selenoproteins, including the deiodinases that convert much of the toxic elements, arsenic, mercury, symptoms, screening for adrenal fatigue, and inactive T4 to active T3, and glutathione peroxidase, and cadmium. thyroid dysfunction. an important antioxidant. Arsenic and mercury reduce selenium’s bioavailability and disrupt thyroid health. Consider for: Arsenic, mercury, and cadmium represent 3 of the 4 Smokers, patients at risk of exposure to toxic most toxic heavy metals according to the CDC. Lithium heavy metals, or patients with thyroid issues is important for brain health in trace amounts but is toxic and/or possible disruption of T4 to T3 conversion when used in excessive amounts pharmacologically. due to excesses or deficiencies of the elements tested. Comprehensive Male Profiles Comprehensive Male Profile I combines a male ✔ Toxic & Essential Elements - Urine includes: version of ZRT’s popular Salivary Hormone Profile Iodine, Selenium, Bromine, Lithium, Arsenic, Cadmium,  Creatinine is measured in all samples to These profiles include both saliva and dried blood spot III with our Essential Thyroid Profile in dried blood Mercury correct results for urine dilution. tests, and provide a broad assessment of possible spot. For men, PSA is included instead of the less hormonal imbalances because they assess sex, relevant (for men) salivary progesterone. adrenal, and thyroid hormone levels. These three hormone systems work in harmony, and an imbalance Comprehensive Male Profile II tests only the in one system affects the balance of the others as well. diurnal cortisol in saliva, while the sex and thyroid Comprehensive testing allows the health care provider to hormones are all tested in dried blood spot. Allows determine appropriate treatment to restore balance and physicians to monitor for estrogen dominance, achieve overall wellness. hypogonadism, andropause; full assessment of Toxic & Essential Elements - Blood Toxic & Essential Elements - Blood Profile thyroid health, including screening for hypo or assesses an individual’s levels of the essential hyperthyroidism, determining Free T4 levels as well ✔ Comprehensive Male Profile I includes: Essential elements are only conducive to optimal nutrients zinc, copper, selenium, and magnesium, as Free T3 levels, testing for autoimmune thyroid and their exposure to the toxic heavy metals Saliva: E2, T, DS, Cx4 health when they are within optimal ranges – levels disease, and monitoring thyroid replacement mercury, cadmium, and lead. Blood Spot: PSA, TSH, fT3, fT4, TPOab that are too low or too high can have detrimental dosages. effects on health – and exposure to toxic heavy metals ✔ Comprehensive Male Profile II includes: has multiple adverse health effects. Dried blood spot Consider for: Consider for: Saliva: Cx4 testing represents red blood cell levels of the nutritional Smokers; patients with exposure to toxic heavy Blood Spot: E2, total; T, total; SHBG; DS; PSA; TSH; fT3; Fatigue, sleep disturbance, decreased cognition, elements magnesium, zinc, and copper, revealing metals through hobbies, work, or dentistry; fT4; TPOab depression, low libido, erectile dysfunction (ED), deficiencies earlier than a typical serum test, and is a people who live or have lived in older homes or infertility, loss of bone and muscle mass, weight convenient alternative to whole blood testing for lead. gain, adrenal and thyroid dysfunction. areas where metals (e.g., lead) may be present in drinking water; and patients whose health issues ✔ Toxic & Essential Elements - Blood includes: could be a result of nutritional deficiencies or  Don’t need PSA? Select one of the female Mercury, Cadmium, Lead, Zinc, Copper, Selenium, imbalances in essential elements. profiles instead. Magnesium

21 22 TEST SPECIALTIES PROFILE | NEUROTRANSMITTER TEST SPECIALTIES | HEAVY METALS ELEMENTS & ESSENTIAL Comprehensive Toxic & Essential Comprehensive Toxic & Essential Elements Profile NeuroAdvanced Profile assesses an individual’s levels of the essential Elements nutrients iodine, selenium, zinc, copper, magnesium, In the neurological system, hormones are synergistic with neurotransmitters – modulating their production, signaling We are all exposed to different amounts of essential and lithium, and bromine, and their exposure to the toxic and metabolism. Because of this complex interplay, testing hormones and neurotransmitters together is an ideal way toxic elements depending on where we live, our diet and elements arsenic, cadmium, lead, and mercury. to generate a more precise clinical assessment. Elements are also important for brain health - deficiencies in iodine or supplementation routine, and environmental pollution selenium compromise the neuroprotective functions of thyroid hormones and lithium is implicated in neuroprotection of the air we breathe. Essential elements are only Consider for: and regeneration. Heavy metals on the other hand disrupt neurotransmitter synthesis, metabolism, and signaling, conducive to optimal health when they are within optimal Smokers; patients with exposure to toxic heavy metals contributing to the burden of neurological dysfunction. ranges – levels that are too low or too high can have through hobbies, work, or dentistry; people who live Combined testing of neurotransmitters with hormones and/or neurotransmitters with heavy metals and nutrients gives detrimental effects on health – and exposure to toxic or have lived in older homes or areas where metals practitioners a diagnostic edge over the traditional psychological inventory. It offers the advantage of zeroing in on heavy metals has multiple adverse health effects. The (e.g., lead) may be present in drinking water; and which therapies are best suited for individual patients – cutting down on the time-consuming process of trial-and-error comprehensive profile allows a complete assessment of patients whose health issues could be a result of for identifying treatment options. This testing also allows practitioners to monitor individual biochemical changes during the most important elements implicated in health-related nutritional deficiencies and after intervention. effects, as it includes a measure of both short and long or imbalances in essential elements. term exposure to all 4 of the most toxic environmental ✔ NeuroAdvanced Profile Includes: heavy metals, as well as highlighting nutritional element  Creatinine is measured in all samples to correct deficiencies earlier than a typical serum test. results for urine dilution. GABA, Glu, Gly, DA, Epi, NE, HIST, 5-HT, PEA, DOPAC, HVA, 5-HIAA, NMN, VMA Trp, Kyn, 3-OHkyn, Tau, Gln, His, N-MeHist, Tyra, KynAc, Xanth, Tyr, Crtn ✔ Comprehensive Toxic & Essential Elements Profile includes: Dried Urine: Iodine, Selenium, Bromine, Lithium, Arsenic, Consider for: + Add-On Options Cadmium, Mercury Testing neurotransmitters in patients with  Saliva Hormones  Diurnal Cortisol, Norepinephrine Blood Spot: Mercury, Cadmium, Lead, Zinc, Copper, a suspected neurochemical imbalance can E2, Pg, T, DS, C & Epinephrine Selenium, Magnesium help assess individual biochemistry and get  Urine Hormones Dried Urine: Free Cortisol x4, to the root of persistent issues such as: E2, Pregnanediol, Allopregnanolone, Free Cortisone x4, NE x4, Epi x4  Mood / affective disorders Androstenedione, T, Epi-T, DHT, DHEA,  Diurnal Cortisol, Melatonin,  Adrenal dysfunction 5α,3α-Androstanediol Norepinephrine & Epinephrine  Addictive behaviors  Diurnal Cortisol Dried Urine: Free Cortisol x4,  Sleep problems Dried Urine: Free Cortisol x4, Free Cortisone x4, Melatonin (MT6s)  ADD / ADHD or OCD Free Cortisone x4 x4, NE x4, Epi x4  PMS / PMDD  Diurnal Cortisol & Melatonin  Urine Toxic & Essential Elements Dried Urine: Free Cortisol x4, Iodine, Selenium, Bromine, Lithium,  Creatinine is measured in all samples Arsenic, Cadmium, Mercury to correct results for urine dilution. Free Cortisone x4, Melatonin (MT6s) x4

23 24 TEST SPECIALTIES CASCADES | NEUROTRANSMITTER TEST SPECIALTIES CASCADES | NEUROTRANSMITTER Neurotransmitter Cascades

25 26 TEST SPECIALTIES TESTING | WELLNESS TEST SPECIALTIES TESTING | WELLNESS Weight Management The Weight Management Profile identifies hormonal imbalancesthat contribute to obesity, weight gain and difficulty losing or The Wellness Suite sustaining a healthy weight. Used as a screening tool, it serves as an early indicator of insulin resistance and risks for metabolic syndrome and diabetes. Wherever you are on your wellness journey, there is a profile to help

✔ Weight Management Profile includes: you maximize your potential. Saliva: E2, Pg, T, DS, Cx4 Blood Spot: TSH, Vitamin D2/D3, Insulin, HbA1c

Weight Management Profile allows physicians to isolate + Optional Thyroid Add-on: Consider for: specific imbalances of one or more hormones that Wellness Metrics Profile Free T3, free T4, and TPOab antibodies provide a better Menopause/andropause patients, people contribute to weight gain, slowed metabolism, increased estimation of thyroid hormone bioavailability to facilitate This screening profile helps identify specific hormone interested in a general wellness assessment, body fat deposition, and food / sugar cravings. Facilitates effective thyroid therapy. imbalances associated with menopause/andropause, PCOS screening. correction of imbalances for weight control, and risks for Consider when: PCOS, excess weight gain or obesity, vitamin D cardiometabolic disease and diabetes. Symptoms of thyroid deficiency are problematic. deficiency, and hypothyroidism. As a risk assessment + Optional Thyroid Add-on: Consider for Women: profile, it allows for early detection of insulin resistance, Add on thyroid markers fT3, fT4 and TPOab With premenstrual weight gain and fluid retention; + Optional Cardio Add-on: metabolic syndrome, and type 2 diabetes. for a more complete thyroid assessment perimenopausal and / or menopausal weight gain in Cardiometabolic risk markers hsCRP, triglycerides, total hips /thigh, and / or inability to lose / tendency to regain cholesterol, LDL, HDL and VLDL cholesterol for early ✔ Wellness Metrics Profile includes: + Optional Cardio Add-on: weight, central obesity, PCOS, adrenal and thyroid detection of pro-inflammatory CVD risks and pre-diabetes. Saliva: E2, Pg, T, DS, Cx4 blood lipids TG, CH, HDL, LDL, and VLDL dysfunction; breast cancer risks. Consider for: Blood Spot: TSH, D2/D3, Insulin, HbA1c for a more complete cardiovascular risk Abdominal obesity, and symptoms of insulin resistance / assessment. Consider for Men: metabolic syndrome. With andropausal weight gain in hips / thighs (female fat distribution pattern) and / or inability to lose / tendency to regain weight, central obesity, adrenal and thyroid dysfunction; prostate cancer risks. Fitness Metrics Profile Consider for: People pursuing a fitness regimen who want Used when starting out on a fitness journey and to achieve better hormone balance and during the program, this profile identifies hormone Sleep Balance Profile Sleep Balance Profile allows physicians to pinpoint cardiometabolic health. imbalances of melatonin and cortisol circadian rhythms imbalances or vitamin D deficiency that can affect ZRT is the only laboratory offering testing for the circadian associated with acute or chronic sleep disturbances. performance or increase injury risk, and monitors + Add-on Option: rhythm of melatonin in concert with cortisol and cortisone progress in improving health fitness by tracking Add on thyroid markers fT3, fT4 and TPOab hormonal and blood lipid changes. for a more complete thyroid assessment; to assess sleep / wake cycle dysfunction. Circulating Consider for: melatonin is efficiently hydroxylated and conjugated insulin, HbA1c, and hsCRP to detect Patients with inability to get to sleep, frequent waking, or with sulfate in the liver to form its primary metabolite, ✔ Fitness Metrics Profile includes: cardiometabolic risk; and LH for a better chronic sleeplessness affecting vitality, cognition, weight, 6-sulfatoxymelatonin (MT6s), and excreted into urine; it Blood Spot: E2, Pg, T, DS, C, SHBG, TSH, TG, picture of endogenous steroid synthesis. and diabetes / cardiovascular disease risks. is this metabolite that is measured in the Sleep Balance CH, HDL, LDL, VLDL

Profile. Adrenal cortisol, produced in response to stress, is + Optional Norepinephrine & Epinephrine Add-on: also known for its diurnal variation linked to the sleep/wake cycle. It has the opposite pattern to melatonin production Gives a better picture when there are adrenal issues in a healthy individual.  Creatinine is measured in all samples to correct results for urine dilution. Consider for: ✔ Sleep Balance Profile includes: Elite Athlete Metrics Profile Athletes who want to identify barriers to Dried Urine: MT6s x4, Free Cortisol x4, Free Cortisone x4 This profile helps identify hormone imbalances or achieving optimal performance and to vitamin D deficiency that can affect performance, prevent injury or overtraining syndrome. increase injury risk, or prevent an athlete from CardioMetabolic Profile Consider for: competing at their highest level. It is best to start with + Add-on Option: Atherosclerosis, CVD, type 2 diabetes, a baseline before rigorous training begins, and to track Add on insulin, HbA1c, hsCRP, and This profile, entirely in dried blood spot collected after an dyslipidemia, hypertension, infertility, insulin hormones throughout a training regimen to look for big blood lipids TG, CH, HDL, LDL, and VLDL overnight fast, allows early detection of major indicators resistance, metabolic syndrome, obesity, PCOS, changes that can indicate problems and to make sure to assess cardiometabolic risk; and LH associated with metabolic / insulin resistance syndrome. weight issues. that hormones are optimally balanced right before a for a better picture of endogenous steroid As a screening profile it can facilitate appropriate competition. synthesis. treatment to reduce Type 2 diabetes and cardiovascular disease (CVD) risks. ✔ Elite Athlete Metrics Profile includes: Saliva: E2, Pg, T, DS, Cx4 ✔ CardioMetabolic Profile includes: Blood Spot: TSH, fT3, fT4, TPOab, D2/D3 Blood Spot: Insulin, hsCRP, HbA1c, TG, CH, HDL, LDL, VLDL 27 28 TEST SPECIALTIES | METHYLATION & MEMORY TESTING TEST SPECIALTIES | METHYLATION & MEMORY TESTING Methylation Profile Consider for: People at risk for deficiencies in nutrients, Methylation Diagram Nutritional factors involved in methylation pathways malabsorption issues, gastrointestinal diseases, (see diagram) are vital to the health of the people who have had bariatric procedures, people cardiovascular and nervous systems and to safe over the age of 40, men and women looking to Methylation Pathways steroid hormone metabolism. If these are not at optimal conceive, people who have a family or personal Methylation Pathways levels, risks for cardiovascular disease and dementia history of pernicious anemia. can increase. DNA/RNA Folate Dietary + Supplements SynthesisDNA/RNA Folate Dietary + Supplements ✔ Methylation Profile includes: DNA/RNASynthesis Dihydrofolate Dietary FER, FOL, HCY, B12 Protein DNA/RNA Dihydrofolate Dietary DHFR B3 Protein Methyltransferase

TS DHFR B3 HTP MethyltransferasePathway Methionine TS Serine Tetrahydrofolate HTP PathwayNE Methionine Bioactive EPI Serine Tetrahydrofolate Catechols NE Consider for: SHMT BioactiveDA Methylation & Memory – Basic CatecholEPI Es People at risk for deficiencies in nutrients, Glycine SHMT Catechols DA & Advanced Profiles malabsorption issues, gastrointestinal Glycine SAM COMT Catechol Es 5,10-Methylene diseases, people who have had bariatric MS COMT Nutritional factors involved in methylation pathways THF Folate SAM 5,10-Methylene Methionine Inactive procedures, people over the age of 40, men MS (see diagram) are vital to the health of the THF CycleFolate B3 B12 MethionineCycle Catechols cardiovascular and nervous systems and to safe and women looking to conceive, people who Inactive Cycle B3 B12 Cycle Catechols steroid hormone metabolism. If these are not at optimal have a family or personal history of pernicious SAH MTHFR B3 levels, risks for cardiovascular disease and dementia anemia. People with a family history or SAH increased risk of cognitive decline including MTHFR B3 can increase. A test for brain-derived neurotrophic Adenosine factor (BDNF), important in the development of healthy Alzheimer’s disease. 5-Methyl THF Homocysteine Adenosine neurons, is included. This is vital for assessing nervous 5-Methyl THF HomocysteineSerine system health, especially in concert with steroid and Serine thyroid hormones that regulate its production. Transsulfuration CBS B6 TranssulfurationPathway ✔ Methylation & Memory Basic Profile includes: CBS B6 Pathway E2, Pg, T, TSH, FOL, HCY, B12, BDNF Cystathionine Glutathione ✔ Methylation & Memory Advanced Profile includes: Cystathionine Synthesis/Recycling CGL B6 Glutathione E2, Pg, T, SHBG, DS, C, TSH, fT3, fT4, TPOab, FER, FOL, Synthesis/Recycling HCY, B12, BDNF α-ketobutyrate CGLCysteineB6 Glutathione α-ketobutyrate Cysteine Glutathione

Heavy Metals Citric Acid H O GP GR B2 Lipid Peroxides 2 2 Cycle Heavy Metals Citric Acid H O GP GR B2 Lipid Peroxides 2 2 Cycle H2O

ATP Glutathione H2O Disulphide ATP Glutathione Disulphide Abbreviations Key Abbreviations Key (B2) Vitamin B2 – Riboflavin (Epi) Epinephrine Enzymes (B3)(B2) Vitamin Vitamin B3 –B2 Niacin – Riboflavin (GR)(Epi) Glutathione Epinephrine Reductase CofactorsEnzymes (B6)(B3) Vitamin Vitamin B6 –B3 Pyridoxine – Niacin (GP)(GR) Glutathione Glutathione Peroxidase Reductase (B12)(B6) Vitamin Vitamin B12 B6 – –Cobalamin Pyridoxine (MS)(GP) Methionine Glutathione Synthase Peroxidase Cofactors (Catechol(B12) VitaminEs) Catechol B12 – EstrogensCobalamin (MTHFR)(MS) MethionineMethylenetetrahydrofolate Synthase Reductase (CBS)(Catechol Cystathionine Es) Catechol Beta-synthase Estrogens (NE)(MTHFR) Norepinephrine Methylenetetrahydrofolate Reductase (CGL)(CBS) Cystathionine Cystathionine Gamma-lyase Beta-synthase (SAH)(NE) S-adenosylhomocysteine Norepinephrine (COMT)(CGL) Catechol-o-methyltransferase Cystathionine Gamma-lyase (SAM)(SAH) S-adenosylmethionine S-adenosylhomocysteine (DHFR)(COMT) Dihydrofolate Catechol-o-methyltransferase Reductase (SHMT)(SAM) Serine S-adenosylmethionine Hydroxymethyltransferase (DA)(DHFR) Dopamine Dihydrofolate Reductase (TS)(SHMT) Thymidylate Serine Synthase Hydroxymethyltransferase (DA) Dopamine (TS) Thymidylate Synthase

29 30 UNDERSTANDING ZRT’S TEST REPORT 32 severe The Comments green bars to indicate • , the lab comments. yellow or • red, • Graphs & Therapies & Graphs Symptoms 68 symptoms, self-reported by the patient on the 68 symptoms, self-reported Please refer to our Symptom Guide available Symptoms rated mild (1), moderate (2) or Symptoms rated mild (1), moderate (2) test requisition. for details about symptom at www.zrtlab.com categories. Patient symptoms are summarized into 8 symptoms are summarized Patient hormone imbalance conditions and scored with severity. (3). Graphs show reported levels by age or time to assist by age or time to assist reported levels Graphs show interpretation. of day like cortisol and hormones that vary by time For shows the range as it changes melatonin, the graph plotted are results test the and day a of course the over to the actual time of day the on the graph according Ranges within the graphs are sample was collected. of variation from the to show the degree color-coded range. center of the normal with age, reports hormones that vary in level For on our database of testers not include graphs based the variation using hormone supplementation, showing on each in levels with age. The test result is marked in relation to the graph to indicate where the result falls observed range for the tester’s actual age. ZRT reports display patient-provided supplementation supplementation display patient-provided ZRT reports timing). delivery, (hormone, dose, information

        5 5 4 of al 2 of cal) (1 cal) . For Off Graph 100 100 90 90 02/26/18 80 80 Hydroxytryptophan) (5-Hydroxytryptophan) T3 (Pharmaceuti -T3 P Average T4 ays Last Used)50mcg oral Used)50mcg Last ays 70 70 -HT 7% 9% 21% 15% 39% 47% 17% 25% Alison McAllister, ND. McAllister, Alison (Ordering Provider unless Provider (Ordering specified on page 1) otherwise Alison McAllister, ND. McAllister, Alison (Ordering Provider unless Provider (Ordering specified on page 1) otherwise ) oral ) Days Last Used)1000mg or Used)1000mg Last Days (23 Hours Last Used) Last Hours (23 ded) (1 Days Last Used) Last Days (1 ded) 60 60 Comprehensive Female Profile II 2018 08 02 200 SB Comprehensive Female Profile II 2018 08 02 200 SB 2018 08 02 200 y categor each for ymptoms # # (OTC) (1 D 50 50 Age Age A 40 40 30 30 Last Used)50mg oral 5 oral Used)50mg Last 03/01/18 gual (SL) DHE (SL) gual 20 20 Blood Spot Estradiol utical) (1 Days Last Used Last Days (1 utical) Blood Spot Testosterone ared to total available s available total to ared rogesterone (compounded) rogesterone gesterone (compounded) (1 (compounded) gesterone cal Progesterone (compoun Progesterone cal 10 10 2% 14% 11% 36% 15% 45% 12% 27%

0 0 80 60 40 20 90 80 70 60 50 40 30 20 10

160 140 120 100

pg/mL ng/dL 3 David T. Zava, Ph.D. Zava, T. David Laboratory Director Laboratory David T. Zava, Ph.D. Zava, T. David Laboratory Director Laboratory 2 -symptoms. reported by the patient comp patient the by -reported 1 (not pictured) 100

Armour (glandular thyroid) (Pharmace thyroid) (glandular Armour RESULTS | 07/28/18 | RESULTS 8% 0% 7% 9% 0% 03:00 11% 21% 22% © 1998-2018 ZRT Laboratory, LLC. All rights reserved. rights All LLC. Laboratory, ZRT © 1998-2018 © 1998-2018 ZRT Laboratory, LLC. All rights reserved. rights All LLC. Laboratory, ZRT © 1998-2018 90 00:00 80 include their professional comments in addition to, or in lieu of .zrtlab.com/patient 70 21:00 estosterone (compounded) (1 Days Last Used)5mg sublin Used)5mg Last Days (1 (compounded) estosterone T 60 18:00 continued 50 Age 15:00 Time of Day of Time 40 12:00 estosterone) estosterone) 30 T Saliva Cortisol Saliva Results T Patient Reported Symptoms Reported Patient 09:00 20 The above results and comments are for informational informational for are comments and results above The medical as construed be to not are and only purposes for practitioner healthcare your consult Please advice. treatment. and diagnosis Blood Spot Progesterone The above results and comments are for informational informational for are comments and results above The medical as construed be to not are and only purposes for practitioner healthcare your consult Please advice. treatment. and diagnosis 10 06:00 Feet or Hands or Feet Graphs below represent averages for healthy individuals not using hormones. Supplementation ranges may be may ranges Supplementation hormones. using not individuals healthy for averages represent below Graphs 0.5mg topical Biestrogen (E2 + E3) (compounded) (1 Days Last Used)100mg topical Pro topical Used)100mg Last Days (1 (compounded) E3) + (E2 Biestrogen topical 0.5mg 0.5mg topical Biestrogen (E2 + E3) (compounded) (23 Hours Last Used)100mg topical P topical Used)100mg Last Hours (23 (compounded) E3) + (E2 Biestrogen topical 0.5mg topi Used)100mg Last Days (1 (compounded) E2) + E3 (80/20 Biestrogen topical 0.5mg 2 8 6 4 5 Symptom Categories below show percent of symptoms self symptoms of percent show below Categories Symptom 03:00 - 0 12 10 25 20 15 10

ender

Fibrocystic T Evening Morning Comments usage (if applicable). ZRT providers Individualized comments which correlate lab results, symptoms and hormone can choose to levels in relation to intensity page is a thorough explanation which provides a better understanding of tested symptoms (mild, moderate, severe), menstrual history in women, and supplementation at the of self-reported symptoms do not influence lab results, but are included in the individualized time of testing. The self-reported comments as they relate back to lab results.

ng/mL ng/mL - - - - Thinking emperature Cold emperature Androgens (DHEA/ Androgens Dry or Brittle or Dry Body or Facial Increased Loss Scalp T Androgens (DHEA/ Androgens - - - 8/15/2018 8:12:43 AM 8/15/2018 8:12:43 8/15/2018 8:12:43 AM 8/15/2018 8:12:43 Cholesterol High Cholesterol Constipation Depressed Fatigue Fatigue Fibromyalgia Foggy Goiter Hair Hair Hair Headaches Loss Hearing Palpitations Heart Hoarseness Flashes Hot Incontinence Infertility Irritable Decreased Libido Lapse Memory Swings Mood Decreased Size Muscle Brittle or Breaking Nails Nervous Sweats Night Numbness SYMPTOM CATEGORIES Deficiency Progesterone / Estrogen Deficiency Progesterone / Dominance Estrogen Low High Low Cortisol High Cortisol Hypometabolism Metabolic Syndrome SYMPTOM CHECKLIST Acne Allergies Anxious Changes Bleeding High Pressure Blood Low Pressure Blood Low Sugar Blood Body Loss Bone Cancer Breast Breasts Breasts Sensitivity Chemical Aches and Pains and Aches higher. Please see supplementation ranges and lab comments if results are higher or lower than expected. than lower or higher are results if comments lab and ranges supplementation see Please higher. TEST REPORT | Disclaimer: # 38D0960950 Lic CLIA Therapies 07/28/2018: topical Used)0.5mg Last Days (1 (OTC) Glycine oral Used)30mg Last Days (1 (Pharmaceutical) (T4) Levothyroxine Graphs Days Last Used) GABA5mg oral Melatonin (OTC) (1 Days Last Used)10mg oral Pregnenolone (OTC) (1 Days (1 (OTC) Pregnenolone oral Used)10mg Last Days (1 (OTC) Melatonin oral GABA5mg Used) Last Days Used) Last Days (1 (OTC) 03/01/2018: 02/26/2018: Disclaimer: detailed information on category breakdowns, go to www to go breakdowns, category on information detailed CLIA Lic # 38D0960950 Lic CLIA TEST REPORT |

Outside the Range High/Low Normal Within Range

Note: If applicable, optimal types. This is the ideal method of hormone treatments. Providers can opt to show all reference ranges for the tests included on a separate page of the report. • ZRT is one of the few labs able to show historical test results, if available. These results are displayed directly next to the current results, so it’s easy to see changes over time. ZRT reports the normal / expected range of each marker tested. ranges are provided. Reference ranges are observed ranges based on collected laboratory data. Unlike other labs, patients do not need to stop hormone supplementation to use ZRT’s testing because we have ranges adjusted for age, menstrual status and supplementation for tracking the effectiveness Results for each test are shown slider. on a color-coded • • Results

     5 1 of . T 07/31/18 05:48 07/31/18 T T - R R T 07/28/18 07:30 07/28/18 13:00 07/28/18 19:00 07/28/18 23:00 07/28/18 - - - - . -500) Alison McAllister, ND. McAllister, Alison (Ordering Provider unless Provider (Ordering specified on page 1) otherwise luteal or -luteal R Pg or -luteal Saliva Saliva Saliva Saliva Spot Blood Samples Collected Samples luteal or E or -luteal For research purposes only purposes research For * . w optimal 100 -optimal 150 borderline) -150 = Lo Premeno Premeno L Postmenopausal Premeno (noon) (evening) (night) (morning) (70 -1636 = High. = 08/02/2018 08/08/2018 -466 H Report Date Report it. L ng/m -22.5 L ng/m -3.0 L ng/m -1.9 L ng/m -1.0 2.5 ng/dL -2.5 pg/mL -4.2 µU/mL -3.0 L ng/m -9.5 120 nmol/L -120 µg/dL -290 L pg/m -180 L IU/m 150 L ng/d 20-130 L ng/d 10-45 RANGE (1) (2) Pg/E2 (bloodspot Pg/E2 3.3 1.2 0.6 0.4 15 40 0.7 2.4 0.5 0- 3.7 43 Samples Received Samples aist Beaverton, OR 97008 OR Beaverton, W Unspecified BMI 23.4 2445 Fax: 503 Fax: -2445 H 8605 SW Creekside Place Creekside SW 8605 (2) 73 -466 432 34 31.5 02/26/18 David T. Zava, Ph.D. Zava, T. David Laboratory Director Laboratory eight Height 5 ft 8 in W lb 154 Phone: 503 Phone: L 1.2 0.7 1.0 3.2 03/01/18 © 1998-2018 ZRT Laboratory, LLC. All rights reserved. rights All LLC. Laboratory, ZRT © 1998-2018 (1) 87 97 0.8 2.3 6.7 1.6 3.2 1 = Not applicable; 1 or more values used in this calculation is less than the detectable lim detectable the than less is calculation this in used values more or 1 applicable; Not = 0.9 1.1 555 555 5555 555 555 69 168 70 L N/A 12 RESULTS | 07/28/18 | RESULTS 0.4 Last Menses Last Unspecified Status Menses removed) (ovaries Hysterectomy Comprehensive Female Profile II Profile Female Comprehensive The above results and comments are for informational informational for are comments and results above The medical as construed be to not are and only purposes for practitioner healthcare your consult Please advice. treatment. and diagnosis Test results are generally available 3-5 business days after samples are received at the lab. Test = Less than the detectable limit of the lab. the of limit detectable the than Less = Gender Female DOB yrs) (53 9/30/1964 estosterone 8/15/2018 8:12:43 AM 8/15/2018 8:12:43 T Cortisol Free T3 TPOab* DHEAS Cortisol Progesterone TSH SHBG T4* Free Estradiol Ratio: Pg/E2 Cortisol Cortisol Blood Spot Thyroids Blood Spot Steroids TEST NAME Steroids Salivary

UNDERSTANDING ZRT’S TEST REPORT 31 DIRECTORY OF TESTS DIRECTORY OF TESTS Directory of Tests Saliva, blood spot and dried urine are used for the minimally-invasive hormone testing that is the hallmark of ZRT Laboratory. The simplicity of sample collection and stability of samples in storage and transport have made these ideal for clinical use TESTS CPT Code SALIVA BLOOD SPOT SERUM DRIED URINE as well as research. Serum testing is now also available for some tests. See the table for a list of all our tests and assay methods used. Luteinizing Hormone (LH) 83002 LIA* LIA* EIA Follicle-Stimulating Hormone (FSH) 83001 LIA* LIA* TESTS CPT CODE SALIVA BLOOD SPOT SERUM DRIED URINE Vitamin D (25-OH D2/25-OH D3) 82306 LCMS* Growth Hormone (GH) 83003 LIA* Steroid Hormone Testing Prolactin (PRL) 84146 LIA* Estradiol (E2)** 82670 EIA*/LCMS LCMS* LIA* GCMS Ferritin (FER) 82728 LIA* 2-OH E2, 4-OH E2, 2-MeO E2, 4-MeO E2 82670 GCMS Folate (FOL) 82746 LIA* Estriol (E3) 82677 LCMS* GCMS Vitamin B12 (B12) 82607 LIA* Estrone (E1) 82679 LCMS* GCMS Homocysteine (HCY) 83090 LIA* 2-OH E1, 4-OH E1, 16α-OH E1, 2-MeO E1, 4-MeO E1 82679 GCMS Brain Derived Neurotrophic Factor (BDNF) 83516 EIA* Estrone-3-Glucuronide (E1G) 82679 EIA Thyroid Testing (PregS) 84140 LCMS Free Thyroxine (fT4) 84439 EIA* LIA* Progesterone (Pg)** 84144 EIA*/LCMS LCMS* LIA* Free Triiodothyronine (fT3) 84481 EIA* LIA* Pregnanediol (Pgdiol), Allopregnanediol (AlloPd) 84135 GCMS Thyroglobulin 84432 LIA* Pregnanediol-3-Glucuronide (PDG) 84135 EIA Thyroid Stimulating Hormone (TSH) 84443 LIA* LIA* Allopregnanolone (AlloP) 84140 LCMS GCMS Thyroid Peroxidase Antibodies (TPOab) 86376 EIA* LIA* 17-OH Progesterone (17OHPg) 83498 LCMS Thyroxine (T4), total 84436 TRFIA* 3α-dihydroprogesterone (3αHP) 84144 GCMS Cardiometabolic Testing 20α-dihydroprogesterone (20α-HP) 83498 GCMS Cholesterol (CH), total 82465 Enzymatic Deoxycorticosterone (DOC) 82633 GCMS HDL Cholesterol (HDL) 83718 Enzymatic Androstenedione (Adione) 82157 LCMS GCMS Hemoglobin A1c (HbA1c) 83036 ITA* Testosterone (T)** 84402 LIA*/LCMS High-Sensitivity C-Reactive Protein (hsCRP) 86141 EIA* Testosterone (T)** 84403 LCMS* LIA* GCMS Insulin (Ins), fasting 83525 EIA* Epi-testosterone (Epi-T) 82542 GCMS Triglycerides (TG) 84478 Enzymatic* 5 -dihydrotestosterone (5 -DHT) 82642 LCMS GCMS α α Neurotransmitter Testing DHEA (D) 82626 LCMS GCMS 5-HIAA 83497 LCMS DHEA-S (DS) 82627 EIA*/LCMS LCMS* LIA* Dopamine (DA), DOPAC 82384 LCMS 7-Keto DHEA (7keto) 82542 LCMS Norepinephrine (NE), Epinephrine (Epi) 82384 LCMS Etiocholanolone (Etio) 82696 GCMS GABA, Glutamate (Glu), Glycine (Gly) 82139 LCMS Androsterone (Andro) 82160 GCMS Tryptophan, Kynurenine, 3-Hydroxykynurenine 82139 LCMS 5α,3α-Androstanediol (5α,3α) 82154 GCMS Taurine, Glutamine, Histidine 82139 LCMS 11-Deoxycortisol (11DC) 82634 LCMS Phenethylamine (PEA), N-Methylhistamine, Tyramine 82542 LCMS Cortisol (C)** 82530 EIA*/LCMS Histamine (HIST) 83088 LCMS Cortisol (C)** 82533 LCMS* LIA* Kynurenic acid, Xanthurenic acid 83921 LCMS Free Cortisol (FC) 82530 LCMS HVA 83150 LCMS Total Cortisol (TC) 82533 GCMS Normetanephrine (NMN) 83835 LCMS Cortisone (Cn) 82530 LCMS Serotonin (5-HT) 84260 LCMS Free Cortisone (FCn) 82530 LCMS Tyrosine 84510 LCMS Total Cortisone (TCn) 82533 GCMS VMA 84585 LCMS Creatinine (Crtn) 82570 LCMS Tetrahydrocortisol (ThC), Tetrahydrocortisone (ThCn) 83491 GCMS Heavy Metals & Essential Elements Testing Corticosterone (Ccn) 82528 LCMS GCMS Arsenic (As) 82175 ICPMS Aldosterone (Ald) 82088 LCMS Bromine (Br) 84311 ICPMS Hormone-Related Testing Cadmium (Cd) 82300 ICPMS ICPMS Bisphenol A 82542 GCMS Copper (Cu) 82525 ICPMS Ethinyl estradiol (EE) 82670 LCMS Iodine (I) 84311 ICPMS* Melatonin (Mel) 82542 LCMS Lead (Pb) 83655 ICPMS Melatonin (MT6s) 82542 LCMS Lithium (Li) 80178 ICPMS Sex hormone binding globulin (SHBG) 84270 LIA* LIA* Magnesium (Mg) 83735 ICPMS Prostate Specific Antigen (PSA) 84153 LIA* LIA* Mercury (Hg) 83825 ICPMS ICPMS Anastrozole (ANZ) 82542 LCMS Selenium (Se) 84255 ICPMS ICPMS Finasteride (FIN) 82542 LCMS Zinc (Zn) 84630 ICPMS Letrozole (LTZ) 82542 LCMS Adjunct to Urine Testing IGF-1 (Somatomedin C) 84305 EIA* LIA* Creatinine (Crtn) 82570 Colorimetric

33 34 PAYMENT OPTIONS & BILLING PRACTICES Payment Options & Billing Practices

Bill Provider (Domestic And Canada)

 Provider distributes kits to patients  Provider is responsible for payment to ZRT and will be billed twice monthly for any completed report  Automatic payment methods are available for provider convenience (required in Canada)  Patient insurance billing is the responsibility of the provider (except Medicare, see below)  Return shipping included

Patient Pay (Domestic Only)

 Provider distributes kits to patients  Patient is responsible for payment to ZRT Laboratory  We will courtesy bill a select group of insurances as a non-contracted provider at ZRT RETAIL price  Return shipping included

International

 Provider distributes kits to patients  Provider is billed twice monthly for any report that has been completed (Patient Pay not available)  Automatic payment required with this option  International shipping charges apply for outbound orders  Patient is responsible for return shipping costs

Insurance Billing ZRT Laboratory will courtesy bill the following insurance companies: Original Medicare Part B, Medicare Advantage Plans, TRICARE, Cigna, Humana and Regence Blue Cross Blue Shield as a non-contracted provider at the ZRT retail price. Please note we do not file secondary insurance. eW recommend patients check with their insurance companies regarding coverage prior to testing.

Medicare Prepayment is required for saliva testing or for any test ordered by providers outside the scope of their practices (ND, DC, LAC, etc.) or who are not enrolled with Medicare, as it is not covered. All providers must order Medicare Kits separately from standard test kits to satisfy Medicare Regulations. ZRT Laboratory will courtesy bill Medicare for all payment options.

35 CLINICAL RESEARCH & STUDY TESTING CLINICAL RESEARCH & STUDY TESTING Clinical Research & Study Testing Pioneer Alongside ZRT Laboratory

The range of testing options we have developed is suited to research applications Research is at the heart of everything we do. We are involved in research collaborations because samples are easy to collect, store, and ship for testing, and our results with academic institutions, research organizations and hospitals across the globe. The are highly accurate. below map highlights countries where we currently have research involvement.

Because collected samples are stable for weeks (saliva) or months (DBS and dried urine) and do not need to be shipped frozen, research can be carried out even in remote areas and samples shipped via regular mail. ✔ United States ✔ Sweden We invite collaborations with clinicians involved in research, including partnerships in clinical trials that require a CLIA- ✔ Canada ✔ New Zealand certified testing laboratory for analyses. We provide sample collection materials for serum, saliva, dried blood spot, or ✔ Australia ✔ South Africa dried urine samples. Research samples are tested at ZRT by state-of-the art methodology, including FDA-approved ✔ Switzerland ✔ Taiwan immunoassays, enzymatic assays, inductively-coupled plasma mass spectrometry (ICP-MS), gas chromatography tandem mass spectrometry (GC-MS/MS), and liquid chromatography tandem mass spectrometry (LC-MS/MS). ✔ Italy

Visit our website to see a current list of published research papers and a list of abstracts and posters presented at scientific meetings.

LEARN MORE If you are interested in a research collaboration with ZRT, or if you wish to partner with us for clinical trial testing, contact us for more information. Call 1.866.600.1636 or visit www.zrtlab.com/research/research-collaboration-inquiry/

37 38 GENERAL INFORAMTION

General Information

Contact Info Mailing Address Telephone: 503.466.2445 ZRT Laboratory Toll-free: 1.866.600.1636 8605 SW Creekside Place Fax: 503.466.1636 Beaverton, OR 97008 Email: [email protected] Website: www.zrtlab.com

CPT Codes The American Medical Association’s Current Procedural Terminology (CPT®) codes in ZRT Laboratory’s Test Directory are provided for informational purposes only. CPT codes are provided only as a guide to assist providers with billing. ZRT recommends that clients confirm CPT codes with their Medicare administrative contractor, as requirements may differ. CPT codingis the sole responsibility of the billing party. ZRT assumes no responsibility for billing errors due to reliance on the published CPT codes.

Health Insurance Portability & Accountability Act (HIPAA)

ZRT Laboratory is committed to complying with privacy and security standards outlined in the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health Act. Notice of Privacy Practices may be found at www.zrtlab.com.

39 40 866.600.1636 | [email protected]